A pivotal legal discussion is set for Wednesday as a federal judge evaluates whether a spending measure enacted last July, which halted Medicaid payments to Planned Parenthood, should remain operative amid ongoing legal disputes.

President Donald Trump’s legislation, aimed at fiscal reductions, specifically targets entities that both offer abortion services and receive annual Medicaid reimbursements exceeding $800,000. While Planned Parenthood contends that this law breaches constitutional rights, anti-abortion proponents have praised the move.

An appellate court has authorized the law’s enforcement starting in September, pending further examination of Planned Parenthood’s legal objections by a subordinate court.

In anticipation of the court session, a Wednesday morning report from Planned Parenthood highlighted a significant financial impact, citing a $45 million expense incurred in September alone. This amount reflects the cost clinics have shouldered for Medicaid patient treatments, a financial burden deemed unsustainable by the organization.

For nearly half of Planned Parenthood’s clientele, Medicaid is crucial for their healthcare needs, excluding abortion services, which federal insurance already does not cover. This program is essential for millions of financially disadvantaged and disabled Americans.

Legal fight

Planned Parenthood Federation of America and its member organizations in Massachusetts and Utah, as well as a major medical provider in Maine, filed lawsuits against Health and Human Services Secretary Robert F. Kennedy Jr. in July. The Maine provider has been forced to stop it’s primary care services while its lawsuit works its way through the courts.

In the meantime, seven states — California, Colorado, Massachusetts, New Jersey, New Mexico, New York and Washington — have directed state funds to compensate for lost federal Medicaid reimbursements.

That has covered roughly $200 million of the $700 million that the organization spends annually on Medicaid patients, according to Planned Parenthood.

In light of the shortfall, some clinics will force Medicaid patients to pay out of pocket while others will close altogether, adding to the 20 Planned Parenthood affiliated clinics that have closed since July and the 50 total that have closed since the start of Trump’s second term.

“The consequence is for patients who are going to be forced to make impossible choices between essential services,” Planned Parenthood President and CEO Alexis McGill Johnson said in an interview with The Associated Press.

Abortion at the heart of the debate

Carol Tobias, president of the National Right to Life Committee, said Trump’s legislation is a step in the right direction. Even though federal tax dollars aren’t used for abortions directly, she said taxpayers are contributing to abortion services even if they are morally or religiously opposed since Medicaid reimbursements help organizations that provide them stay afloat.

“To be forced to pay for that is just very objectionable,” Tobias said.

She suggested Planned Parenthood could stop offering abortions if it wanted to keep providing medical care to vulnerable populations.

Planned Parenthood’s president has doubled down on the organization’s commitment to providing abortions.

“The government should not play a role in determining any pregnancy outcomes,” Johnson said.

A range of services hit

Planned Parenthood is the country’s largest abortion provider, but abortions only constituted 4% of all medical services in 2024, according to the organization’s annual report. Testing for sexually transmitted infections and contraception services make up about 80%. The remaining 15% of services are cancer screenings, primary care services and behavioral health services.

Jenna Tosh, CEO of Planned Parenthood California Central Coast, said in an interview that the Medicaid cuts threaten abortion and non-abortion medical care in equal measure. Roughly 70% of patients who use Planned Parenthood California Central Coast rely on Medicaid, she said.

“Many of our patients, we are their primary provider of health care,” Tosh said. “You really start pulling at the thread of the entire health care safety net for the most vulnerable people.”